Volume and outcomes after esophageal cancer surgery: the experience of the Region of Lombardy-Italy.

Surgical procedures for cancer of the esophagus are complex operations, with considerable perioperative morbidity and mortality that require high use of resources. Recent reports indicate better results with centralization of these procedures, referring patients to high-volume dedicated hospitals. The aim of this study was to analyze the results of resective surgery for cancer of the esophagus and cardia performed in hospitals of the Region of Lombardy over the period 2005-2011, in terms of volume of operations, 30-day postoperative mortality, and length of hospitalization. The results showed a significant relation between reduction of mortality rate and number of resections performed in intermediate- and high-volume centers. In the Region of Lombardy there is an inverse relation between volume of esophagectomies in the single hospital, length of postoperative hospital stay, and postoperative 30-day mortality. Centralization of care on a regional level and standardized clinical pathways of diagnosis and care at single healthcare organizations and professionals should be implemented to improve clinical results in patients affected by esophageal and cardia cancer.